Improving Provider Data Accuracy with Blockchain
Session 126, February 13, 2019
Jason O’Meara, Senior Director Enterprise Management and Architecture, Quest Diagnostics
Kyle Culver, Principal Blockchain Architect, Humana
Mike Jacobs, Senior Distinguished Engineer, Optum
Dan D’Orazio, Chief Executive Officer, Sage Growth Partners
Jason O’Meara, Senior Director Enterprise Management and
Architecture, Quest Diagnostics
Kyle Culver, Principal Blockchain Architect, Humana
Mike Jacobs, Senior Distinguished Engineer, Optum
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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WELCOME
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1. Define the current state of provider data exchange.
2. Evaluate the use of blockchain technology to address
healthcare challenges.
3. Demonstrate how healthcare organizations can work
together to leverage blockchain technology to provide
more effective patient care.
Today’s learning objectives
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Jason O’Meara
Senior Director Enterprise
Management and Architecture
Quest Diagnostics
Kyle Culver
Principal Blockchain
Architect
Humana
Mike Jacobs
Senior Distinguished
Engineer
Optum
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Provider data management
Maintaining Accurate Demographics Within a
Provider Directory is a Required Capability for Health Plans
Provider directory information changes often, and is used by
members and sales reps frequently
Over 18 months, half of directory
entries have a change*
One of a health plan member’s most
common interactions with their plan is
searching its provider directory
Name
Address
Phone Number
Specialty
Accepting New Patients Indicator
Example Demographic Elements
*Enclarity. (2014). A business case for fixing provider data issues. Retrieved February 26, 2018, from lexisnexis.com
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Provider data challenges
Name Address Phone Accepting
Patients
Other
Data
$
2.1
Billion/Year
Payers
Collectively
Spend Improving
Provider Data*
Patients seek care from out-of-network providers
Providers endure unnecessary billing and administrative complications
Health information exchanges (HIEs) and organizations cannot effectively
enable the secure sharing of patient information
Health plans have higher than necessary administrative burden and costs,
impact consumer costs and risk violating state and federal requirements
Impact of Incomplete, Poor Quality Data
*“Streamlining Provider Data Management Could Save Billions…but Is It Possible?”, Health Plan Week, Vol 27, No. 4 (January 2017).
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Synaptic Health Alliance
Aetna, Ascension, Humana,
Multiplan, Optum, Quest
Diagnostics and
UnitedHealthcare have
formed the Alliance to explore
how blockchain technology
could help address some of
the toughest problems in
healthcare
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What we learned about an alliance
Transparency and open dialogue is critical the success of the
alliance.
Mutual respect on hot-button topics is necessary: brand,
finances, intellectual property, data access and resources.
Governance provides the framework for ongoing collaboration
and decision-making.
Alliance complexity reduces velocity: multi-party decisions,
resource variability, compared to a single organization with a
single agenda.
Efficiencies when working together to tackle an industry
problem vs. working in our own siloes.
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Business value assessment approach
Overlap analysis to select single market: Texas
Single market to minimize impact on operational
resources
Point-in-time snapshot of data
Independent theories of where to discover value
Traditional outbound call campaigns to test
theories
Small sample sizes (e.g. 1,900 records per org.)
provided directional guidance
Decoupled business value assessment from
technology development to move faster
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What we learned with the technology
We evolved with the technology. Initial experiences with
several blockchain technologies led us to select Quorum.
How to optimize smart contract data structures. Novel
contracts that can work with data between all
organizations.
How to deploy for enterprise-class needs. A truly
decentralized multi-cloud, multi-enterprise blockchain
network was proven out.
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Synaptic network
Node
Node
Node
Node
NodeNode
Node
Node
Smart Contracts
Quorum
Blockchain
All nodes are the
same but owned by
different alliance
members
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Overall finding and relevance
Findings provide directional guidance toward coordinating
provider directory work across alliance members.
CMS considers inactive locations listed in a provider
directory to be a deficiency of the highest weight.*
The most immediate benefits were found to be the
identification of inactive locations and mismatched
addresses.
*CMS, Online Provider Directory Review Report 2018
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Representative Findings: Inactive Locations
Percent of the
time a member’s
active provider
record should be
changed to
inactive based
on shared data.
Potential percentage
with the correlation
of additional
business data.
67-88% 88+%
+ Claim Data
+ Attestation
4-5x
Anticipated increase in the outreach call effectiveness
when removing inactive locations compared against
typical phone outreach.
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Representative Findings: Address Mis-
matches
80-89% 89+%
Percent of the
time an address
for a members
active provider
record should be
changed based
on shared data.
Potential
percentage with
the correlation of
additional
business data.
+ Claim Data
+ Attestation
Some members found the potential for write-off recovery opportunities
that could put real dollars back into the business.
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Questions?
Answers.